Addiction

MedicalResearch.com Interview with: “Drugs” by Ben Harvey is licensed under CC BY 2.0William G. Honer, MD, FRCPC, FCAHS Jack Bell Chair in Schizophrenia Professor and Head, Department of Psychiatry University of British Columbia Vancouver, BC MedicalResearch.com: What is the background for this study? Response: The Province of British Columbia, Canada, has experienced a tremendous increase in the number of opioid related overdoses and deaths. In 2012, there were 269 drug overdose deaths, five years later in 2017 the overdose deaths are predicted to have increased 500%. Toxicology studies of deaths, and examination of seized drugs indicate fentanyl is the major cause. These indirect measures suggest widespread exposure to fentanyl in opioid users, however direct studies of the extent of exposure of opioid users to fentanyl in the community are lacking. We carried out a community-based, longitudinal study using fentanyl testing in urine samples from volunteer participants. (It is called the “Hotel Study” since many of the participants live, or have lived in single room occupancy hotels) 

MedicalResearch.com Interview with: “Alcohol Poisoning PSA Video Shoot” by Stop Alcohol Deaths, Inc. is licensed under CC BY 2.0Dr. Frank de Vocht Senior Lecturer in Epidemiology and Public Health Research Academic Lead Year 1 MBChB (MB21) ‘Foundations of Medicine’ Programme Population Health Sciences Bristol Medical School University of Bristol  MedicalResearch.com: What is the background for this study? Response: We were interested in prospectively investigating whether people who drink alcohol in the general population (so not patients), and who indicated that the were planning to reduce their consumption or complete stop drinking in the near future would, on average, succeed and have reduced consumption six months later. 

MedicalResearch.com Interview with: [caption id="attachment_39573" align="alignleft" width="149"] Dr. Molina[/caption] Brooke S. G. S Molina, PhD Professor of Psychiatry, Psychology and Pediatrics University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been inconsistency across previous studies of children with ADHD and their risk of substance use in...

[caption id="attachment_18486" align="alignleft" width="300"]Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Marijuana plant (Cannabis sativa)[/caption] MedicalResearch.com Interview with: Divya Ravi, MD, MPH The Wright Center for Graduate Medical Education Scranton, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is evidence to suggest that Marijuana can bring about changes at the tissue level and has the ability to potentiate vascular disease, in ways similar to tobacco.  With change in legalization and increase usage trends, we conducted this review to examine the known effects of marijuana on cardiovascular outcomes and risk factors, given that cardiovascular disease remains the greatest cause of morbidity and mortality worldwide. Our review found insufficient evidence to draw meaningful conclusions that marijuana use is associated with cardiovascular risk factors and outcomes. The few studies that suggested a possible benefit from marijuana use, were cross-sectional, and were contradicted by more robust longitudinal studies that reported potential harmful effects.

MedicalResearch.com Interview with: “Alcohol” by Jorge Mejía peralta is licensed under CC BY 2.0Dr. Eirik Degerud, PhD Norwegian Institute of Public Health MedicalResearch.com: What is the background for this study? Response: Alcohol-related hospitalisations and deaths are more frequent among individuals with low socioeconomic position, despite that they tend to drink less on average. This is referred to as the alcohol-harm paradox. Alcohol is associated with both higher and lower risk of cardiovascular disease, depending on the drinking pattern. We wanted to assess if the paradox was relevant to these relationship also.

“cocaine photo” by Imagens Evangélicas is licensed under CC BY 2.0MedicalResearch.com Interview with: Mary Kay Lobo, PhD Associate Professor University of Maryland School of Medicine Department of Anatomy and Neurobiology Baltimore, MD 21201  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Altered energy balance has been studied in drug abuse but the fundamental source of energy, mitochondria, has not been well examined.  In this study we found that a molecular regulator of mitochondrial fission (division) is increased in the nucleus accumbens, a major brain reward region, of rodents exposed to repeated cocaine and postmortem samples of cocaine dependent individuals.  We further found that mitochondrial fission is increased in a nucleus accumbens neuron subtype in rodents that self-administer cocaine. Pharmacological blockade of mitochondrial fission can prevent physiological responses to cocaine in this neuron subtype while reducing cocaine-mediated behaviors.  Finally, genetic reduction of mitochondrial fission in this neuron subtype in the nucleus accumbens can reduce drug (cocaine) seeking in rodents previously exposed to cocaine. In contrast, increasing mitochondrial fission, in this neuron subtype, enhances cocaine seeking behavior.

MedicalResearch.com Interview with: “Checking your phone and vaping as you do” by Alper Çu?un is licensed under CC BY 2.0Richard Allen Miech, PhD Research Professor, Survey Research Center Institute for Social Research University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Monitoring the Future conducts annual, nationally-representative surveys of ~45,000 adolescents every year to assess trends in substance use. We track which drugs are gaining traction among adolescents and which are falling out of favor. The survey draws separate, nationally-representative samples of 8th, 10th, and 12th grade students from about 400 total schools every year. Once a recruited school agrees to participate, a field interviewer travels to the school to administer the paper-and-pencil survey, typically in classrooms. The project is funded by the National Institute of Drug Abuse and is carried out by the University of Michigan. More details on the project's survey design and survey procedures can be found in chapter 3 here: http://monitoringthefutu re.org/pubs/monographs/mtf- vol1_2016.pdf

MedicalResearch.com Interview with: [caption id="attachment_38983" align="alignleft" width="200"]MedicalResearch.com Interview with: Greta Hsu PhD Graduate School of Business Stanford University, Graduate School of Business   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations.  As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states.  For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses.

</p/>As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?  We found that some clusters of dispensaries were more conservative in their marketing, continuing and even accentuating an organizational identity focused on therapy and patients.  This was reflected in statements like: “We aim to educate our patients about cannabis treatments and other alternative health approaches to supplement their medicine.”  Counties where the majority of voters voted against legalizing recreational marijuana tended to encourage this increasing focus on therapy.  Dispensaries that embraced the new recreational market took more risk by advertising to a broader, emerging consumer class, which has been bolstered by a growing tourism industry.  These dispensaries de-emphasized their medical orientation and focused more on themes such as product variety and prices.  Dispensaries with this more recreational-oriented marketing tended to be in counties that voted in favor of legalizing recreational use.  Overall, our research suggests local communities hold a great deal of power in affecting how dispensaries present themselves both to consumers and the broader population.  MedicalResearch.com: What should clinicians and patients take away from your report? Response:  In states that have legalized cannabis for adult recreational-use and sales, the law often gives local municipalities flexibility in deciding how easily dispensaries can operate within their boundaries. Many counties have chosen to ban cannabis-related businesses. Others are carefully regulating sales and businesses through zoning and taxes.  Our research suggests that dispensaries are responsive to the level of concern raised by local community members about recreational-use cannabis.  How dispensaries choose to market and present themselves will be shaped by their need to project a positive organizational identity and be accepted as legitimate members of the local community.   MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Many national polls indicate strong support for legalizing the use of cannabis for medical and, to a somewhat lesser degree, recreational uses.  The progression of state-level legalization has been fast and is likely to continue in the coming years.  The overall landscape in the United States is incredibly complex.  Different states has enacted different types of state-level regulations, and different localities within each of these states also differ widely in the types of regulations enacted.  Future research studying dynamics in different states is needed to better understand how this fast-growing industry will continue to evolve.   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Co-opt or co-exist? A study of medical cannabis dispensaries’ identity-based responses to recreational-use legalization in Colorado and Washington Greta Hsu* University of California, Davis Özgecan Koçak Emory University Balázs Kovács Yale University https://gsm.ucdavis.edu/sites/main/files/file-attachments/cannabis_os_final.pdf  Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.  [wysija_form id= Dr. Hsu[/caption]Greta Hsu PhD Graduate School of Business Stanford University, Graduate School of Business MedicalResearch.com: What is the background for this study? What are the main findings? Response: My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations. As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states. For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses. People who use marijuana for medical purposes do not always live near a dispensary, so accessing this product may be quite difficult for some than it would be for others. In and around where you live, you may be able to look into a local dispensary who would be able to administer the products you would need. For example, living in Florida, you'd look into something like florida dispensary to help you find your nearest dispensary. As long as you find a place that works for you, then that's all that matters. As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?

MedicalResearch.com Interview with: “Pills” by Victor is licensed under CC BY 2.0Marissa J. Seamans, Ph.D Postdoctoral Fellow Department of Mental Health Johns Hopkins School of Public Health Baltimore, MD 21205  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many patients report sharing their prescriptions for opioids with family members. What we didn’t know is whether family members of opioid users are more likely to fill opioid prescriptions themselves than family members of non-opioid users. Our study found that the 1-year risk of prescription opioid initiation among family members of prescription opioid users was an absolute 0.71% higher than among family members of non-opioid users. The risks were particularly higher for initial prescriptions with refills or longer days supply.

MedicalResearch.com Interview with: “Cocaine” by Nightlife Of Revelry is licensed under CC BY 2.0Dr. Dave Thomas PhD Health Scientist Administrator National Institute on Drug Abuse  MedicalResearch.com: What is the background for this study? What are the main findings? Response: At the National Institute on Drug Abuse, we support research on all forms of drug use, and are aware that cocaine misuse is on the rise.  We are aware that various forms of drug use can have greater prevalence by race, sex, age and other population characteristics. The main finding of this paper is that cocaine overdose rates are on the rise and that that the group hit hardest is the non-Hispanic black population.

MedicalResearch.com Interview with: Dr. Zoe Weinstein MD Instructor, Boston University School of Medicine Director of the Inpatient Addiction Consult Service Boston Medical CenterDr. Zoe Weinstein MD Instructor, Boston University School of Medicine Director of the Inpatient Addiction Consult Service Boston Medical Center MedicalResearch.com: What is the background for this study? Response: Substance use disorders are highly prevalent, especially among hospitalized patients, however substance use often goes unaddressed in the hospital setting, even if substance use is the underlying cause of the hospitalization (such as a blood stream infection from intravenous drug use). This study reviews the experience of one hospital in starting an Addiction Consult Service to address substance use among hospitalized patients, and help connect them with long-term outpatient addiction treatment directly from the hospital.

MedicalResearch.com Interview with: “Alcohol” by Takahiro Yamagiwa is licensed under CC BY 2.0 Marta Yanina Pepino PhD Department of Food Science and Human Nutrition College of Agricultural, Consumer and Environmental Sciences University of Illinois Urbana, IL  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study is not the first to look at whether sleeve gastrectomy affects alcohol absorption and metabolism. Before our study, there were three published studies in the literature on this issue. However, findings from these studies were discrepant. Two of the studies found that sleeve gastrectomy did not affect blood alcohol levels and one of the studies did found that peak blood alcohol levels were higher when people drink after having a sleeve gastrectomy. All these three studies used a breathalyzer to estimate blood alcohol levels. Our study tested the following two related hypothesis. First, that similar to Roux-en-Y- gastric bypass (RYGB), sleeve gastrectomy accelerates alcohol absorption, which cause peak blood alcohol levels to be higher and much faster than before surgery. Because the breathalyzer requires a 15 min of waiting time between drinking the last sip of alcohol and the time that you can read a good estimate of blood alcohol levels from the breath, we hypothesized that the breathalyzer was not a good technique to estimate peak blood alcohol levels in people who may reach a peak blood alcohol level before those 15 min have passed, such as people who underwent sleeve gastrectomy or RYGB. We found these two hypothesis to be truth: 1) Sleeve gastrectomy, similar to RYGB, can double blood alcohol levels; and 2) The breathalyzer technique is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol (it underestimate blood alcohol levels by ~27% and it may miss peak blood alcohol levels).

MedicalResearch.com Interview with: [caption id="attachment_38357" align="alignleft" width="165"]MedicalResearch.com Interview with: Christine Mauro PhD Assistant Professor Biostatistics Columbia University Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.  We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003). There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.    MedicalResearch.com: What should clinicians and patients take away from your report? Response:  The readers should take away several things.  First, despite men being more likely to use marijuana than women are in all age groups, there were relatively few gender differences in terms of the impact of medical marijuana on marijuana use. Second, we found no evidence of an effect of medical marijuana law enactment in any marijuana use outcome for both men and women aged 12-17.  Lastly, we did see an increase in both past-month use and daily use among past-year users in both men and women aged 26+ after enactment, but no changes in past year marijuana used disorder.    MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Because most states in our sample more recently passed medical marijuana laws, it is possible that not enough time has elapsed to observe meaningful and significant changes in Marijuana Use Disorder. Given the impact Marijuana Use Disorder may have on individuals, families, and society, the prevalence of Marijuana Use Disorder should continue to be monitored regularly.   Second, there is considerable variation across provisions included in different states’ medical marijuana laws; some aspects, such as allowances on home cultivation or dispensaries, might have a role in changes in several health outcome indicators.  In addition, eight states have now legalized recreational marijuana, which may also have an impact on marijuana use outcomes over time. Future analyses should account for this variability in marijuana related policies.   MedicalResearch.com: Is there anything else you would like to add? Response: As marijuana use becomes more prevalent, monitoring state-wide trends in marijuana use by age and gender is important for public health planning. In particular, efforts to prevent and limit injury that may be associated with specific activities, such as driving, may be needed as daily marijuana use increases among adults. Downstream effects, either positive or negative, of a growing proportion of the adult population reporting daily marijuana use in states with medical marijuana laws warrants further attention. Disclosure: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (grant R01 DA037866 to S. S. Martins).   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Christine M. Mauro, Paul Newswanger, Julian Santaella-Tenorio, Pia M. Mauro, Hannah Carliner, Silvia S. Martins. Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004–2013. Prevention Science, 2017; DOI: 10.1007/s11121-017-0848-3   Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.  [wysija_form id= Dr. Mauro[/caption]Christine Mauro PhD Assistant Professor Biostatistics Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: As of November 2016, 28 states have legalized medical marijuana with online dispensary canada providing information for anyone who is interested in finding out more. Several previous studies have found an increase in use for adults after legalization, but not for adolescents. We wanted to examine whether these age-specific findings varied by gender. Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003). There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.

MedicalResearch.com Interview with: “Surgery” by mrpbps is licensed under CC BY 2.0Sagar Patel MD Facial Plastic Surgeon Board Certified Otolaryngology, Head and Neck Surgeon Facial Plastic Surgery Associates, Houston, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Response: While the majority of diverted opioids that are abused originate from pills prescribed for chronic conditions, with 214,000 rhinoplasties performed in the US in 2015, assessing opioid usage after rhinoplasty is an important view into prescription practices for acute pain after surgical procedures. Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed. We them mathematically analyzed.

MedicalResearch.com Interview with: [caption id="attachment_18486" align="alignleft" width="300"]Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Marijuana plant (Cannabis sativa)[/caption] Marcel Bonn-Miller, PhD Adjunct assistant professor Department of Psychiatry Leader of the Substance Abuse and Anxiety Program U.S. Veterans Affairs Department  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A 2015 study found that edible cannabis products (e.g., brownies, cookies, drinks) are often mislabeled.  The FDA has also sent warning letters to a handful of companies selling cannabidiol extracts because of inaccurate labeling of content. This led us to conduct a systematic evaluation of the label accuracy of all cannabidiol extracts sold online.  We tested 84 products from 31 different companies. The primary take-home of this study is that nearly 70 percent of all cannabidiol extracts sold online had over 10% more or less cannabidiol than advertised; 26% of products were over-labeled (less cannabidiol than indicated) and 42% of products were under-labeled (more cannabidiol than indicated).

MedicalResearch.com Interview with: [caption id="attachment_38051" align="alignleft" width="180"]Dr. Wong Dr. Wong[/caption] Shane Shucheng Wong, MD Massachusetts General Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: Medical cannabis is now legal in 29 states and the District of Columbia, and in those areas with active programs, children and adolescents can legally access medical cannabis with certification from their doctor and consent from a parent. This means that doctors and families need to understand what we know and what we don’t yet know about medical cannabis in order to make the best decision for the health of the individual child. Two synthetic cannabinoids – compounds that act on specific receptors in the brain – have been approved for medical use in the U.S., both of which mimic a form of THC (tetrahydrocannabinol), the compound responsible for the “high” of recreational cannabis use. Dronabinol (Marinol) is approved to treat chemotherapy-induced nausea and vomiting in both children and adults, while the pediatric use of nabilone (Cesamet) carries a caution. A third cannabinoid, cannabidiol, is currently in phase 3 trials for treatment of seizures.

MedicalResearch.com Interview with: [caption id="attachment_37962" align="alignleft" width="104"]Sebastiano Mercadante, MD Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center Department of Anesthesia, Intensive Care & Emergencies University of Palermo Palermo, Italy Dr. Mercadante[/caption] Sebastiano Mercadante, MD Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center Department of Anesthesia, Intensive Care & Emergencies University of Palermo Palermo, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are many clinical experiences suggesting that methadone, when optimally used by skilled physicians, has invaluable properties in the management of cancer pain. Methadone used as first opioid may provide interesting advantages due to the low tendency to induce tolerance, while providing a clinical profile similar to that of other opioids. Moreover, methadone possesses other extra-opioid effects that can be of interest.

MedicalResearch.com Interview with: [caption id="attachment_37849" align="alignleft" width="107"]Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts Dr. Saitz[/caption] Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging. The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks.  But current marijuana use was associated with cognitive dysfunction.

MedicalResearch.com Interview with: “no drugs” by Anderson Mancini is licensed under CC BY 2.0Julie K. O’Donnell, PhD Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed. This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.

MedicalResearch.com Interview with: Philipp Gerner MD Candidate - Class of 2018 University of Massachusetts Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids. As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients. Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.

MedicalResearch.com Interview with: [caption id="attachment_37708" align="alignleft" width="150"]Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 Dr. Elixhauser[/caption] Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.

MedicalResearch.com Interview with: “Pills” by Kurtis Garbutt is licensed under CC BY 2.0Christopher M. Jones, PharmD Office of the Assistant Secretary for Planning and Evaluation Office of the Secretary U.S. Department of Health and Human Services  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Although prescription drugs, in particular opioid pain relievers, were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. We found that the prevalence of self-reported past-month use of illicit drugs increased significantly across urban status (large metropolitan, small metropolitan, and nonmetropolitan) between 2003-2005 and 2012-2014. Prevalence was higher for males than females, however, in the large metropolitan group, the percentage increase in prevalence from 2003–2005 to 2012–2014 was greater for females (23.4%) than for males (21.6%). There were notable differences by age. During 2012–2014, respondents aged 18–25 years had the highest prevalence of past-month use of illicit drugs for all urban levels. For respondents in this age group, the prevalence increased slightly from 2003–2005 to 2012–2014 in large metropolitan areas while the prevalence remained stable among small metropolitan area respondents and nonmetropolitan area respondents. Past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years), with the largest decline among small metropolitan area youth.

MedicalResearch.com Interview with: [caption id="attachment_37603" align="alignleft" width="200"]Sheryl Cates RTI International Sheryl Cates[/caption] Sheryl Cates RTI International Durham, NC MedicalResearch.com: What is the background for this study? What are the main findings? Response: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why users prefer edibles relative to other forms of marijuana such as smoking and vaping and concerns regarding the consumption and questions related to, how long do edibles last? And many more! This is important as more states legalize the use of recreational marijuana products. With the increasing popularity of edibles, concerns exist that do not exist with other methods of using marijuana, such as smoking or vaping. These concerns include delayed activation time; accidental ingestion, particularly by children and older adults; and dose titration.

The study team conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) with users of edibles. Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles’ ability to aid in relaxation, reduce anxiety, and alleviate pain more so than smoking marijuana. Concerns and dislikes about edibles included delayed effects, unexpected highs, the unpredictability of the high, and inconsistency of distribution of marijuana in the product. No participants in either location mentioned harmful health effects from consuming edibles as a concern. Although focus group findings are not generalizable, the findings are useful for helping inform policy makers and regulators as they establish regulations regarding the manufacture, labeling, and sale of edibles.

MedicalResearch.com Interview with: [caption id="attachment_18486" align="alignleft" width="200"]Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Marijuana plant (Cannabis sativa)[/caption] Jiries Meehan-Atrash Department of Chemistry, Portland State University Portland, Oregon MedicalResearch.com: What is the background for this study? What are the main findings? Response: The need for this study stems from the rising popularity of cannabis, and specifically the fact that many consumers are under the belief that vaporizing extracts thereof is safer than smoking. While this may in fact have some truth to it, it is clear that we must assess the safety of vaporization a route of administration. The main findings are that vaporizing terpenes under dabbing conditions generates some levels of methacrolein (a noxious irritant) at all temperatures that are hot enough to vaporize cannabinoids, but significant levels arise at higher temperatures that are more commonly used. To do this, you'll need to make sure your dab rig is in excellent condition. At the highest temperature used by consumers, significant levels of benzene arise, a compound that is a potent carcinogen and should be avoided at all costs.

MedicalResearch.com Interview with: Dr. Deborah Dowell, MD MPH Senior Medical Advisor Division of Unintentional Injury Prevention Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? Response: Increases in U.S. life expectancy at birth have leveled off from an average of 0.20 years gained per year from 1970 to 2000 to 0.15 years gained per year from 2000 to 2014. U.S. life expectancy decreased from 2014 to 2015 and is now lower than in most high-income countries, with this gap projected to increase. Drug poisoning (overdose) death rates more than doubled in the United States from 2000-2015; those involving opioids more than tripled. Increases in poisoning have been reported to have reduced life expectancy for non-Hispanic white Americans from 2000-2014. Specific contributions of drug, opioid, and alcohol poisoning to changes in U.S. life expectancy since 2000 were unknown.

MedicalResearch.com Interview with: Benjamin Hansen, Keaton Miller, Caroline Weber [caption id="attachment_21721" align="alignleft" width="200"]A dried Cannabis bud, typical of what is sold for drug use- Wikipedia image A dried Cannabis bud, typical of what is sold for drug use- Wikipedia image[/caption] Department of Economics University of Oregon MedicalResearch.com: What is the background for this study? Response: Recreational marijuana is now, or will soon be, legally available to 21% of the United States population after they follow in Canada's path. All around Canada people can buy marijuana on an online dispensary canada legally with no repercussions but a major concern among policymakers at all levels of government in the US is the trafficking or "diversion" of marijuana from states where it is legal to other states. Though significant measures are in place to prevent large scale drug trafficking by licensed producers, consumers may easily purchase in one state and travel to a different state for consumption or re-sale. Though this policy concern has existed since medical marijuana became available in the 1990s, the extent of this diversion by consumers has been unknown. With recreational marijuana becoming the norm within the states that have made it legal, although policymakers are worried about the potential for trafficking over state lines, it is still legal for those who which to enjoy their cannabis filled vape carts without any repercussions. The cultivation of marijuana is a completely different topic when it comes to the trafficking of marijuana. Although states like Colorado and Oregon have allowed the cultivation of marijuana for both uses, there are states that have legalized cultivation or at least have it for medical use. This has the effect of businesses like LED Grow Lights HQ growing to supply the growing demand. We take advantage of a unique natural experiment in the Pacific Northwest: Oregon opened a recreational market on October 1, 2015, well after Washington's market opened on July 8, 2014. By examining the sales of Washington retailers along the Washington-Oregon border in the months before and after Oregon's market opened, we can measure the extent to which consumers from Oregon crossed state lines to purchase marijuana in Washington.

MedicalResearch.com Interview with: [caption id="attachment_36714" align="alignleft" width="150"]Dr. Julie H. Ishida MD Division of Nephrology, Department of Medicine San Francisco and San Francisco Veterans Affairs Medical Center University of California Dr. Ishida[/caption] Dr. Julie H. Ishida MD Division of Nephrology, Department of Medicine San Francisco and San Francisco Veterans Affairs Medical Center University of California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is becoming increasingly accepted in the United States, and animal studies suggest that marijuana could affect kidney function. However, data in humans are limited to case reports of acute kidney injury related to synthetic cannabinoid use and small cohort studies of relatively short duration. Among 3,765 participants with normal kidney function in the Coronary Artery Risk Development in Young Adults or CARDIA study, my colleagues and I found that higher marijuana use was associated with lower kidney function at the start of the our study. However, we did not find that marijuana was associated with change in kidney function or albuminuria, which is a sign of kidney damage, over long-term follow-up.

MedicalResearch.com Interview with: [caption id="attachment_36629" align="alignleft" width="130"]Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and  Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh Dr. Donohue[/caption] Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC). My colleagues and I analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting. We found that Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose. Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points. Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Our team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.

MedicalResearch.com Interview with: Beth Han, MD, PhD, MPH From Substance Abuse and Mental Health Services Administration, Rockville, Maryland National Institute on Drug Abuse, Bethesda, Maryland and Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services Washington, DC.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Using the 2015 National Survey on Drug Use and Health (NSDUH), this is the first study examining the prevalence of overall prescription opioid use in addition to misuse, use disorders, and motivations for misuse in the U.S. adult population. The 2015 NSDUH collected nationally representative data on prescription opioid use, misuse, use disorder, and motivations for misuse among the U.S. civilian, noninstitutionalized population aged 12 or older. In 2015, NSDUH started to collect data on overall prescription opioid use as well as data on motivations for prescription opioid misuse. This study found that in 2015, 91.8 million (37.8%) U.S. civilian, non-institutionalized adults used prescription opioids, 11.5 million (4.7%) misused them, and 1.9 million (0.8%) had a prescription opioid use disorder. Among adults who used prescription opioids, 12.5% reported misuse and, of those reporting misuse, 16.7% reported a prescription opioid use disorder. The most common reported misuse motivation was to relieve physical pain (63.4%). Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Among adults with misuse, 59.9% reported using opioids without a prescription, and 40.8% obtained prescription opioids free from friends or relatives for their most recent misuse.

MedicalResearch.com Interview with: [caption id="attachment_36469" align="alignleft" width="200"]Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479 Dr. Hernandez-Boussard[/caption] Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Opioid addiction is a national crisis.  As surgery is thought to be a gateway to opioid misuse, opioid-sparing approaches for pain management following surgery are a top priority. We conducted a meta-analysis of 39 randomized clinical trials of common non-pharmalogical interventions used for postoperative pain management. We found that acupuncture and electrotherapy following total knee replacement reduced or delayed patients’ opioid use.